About the Company:

Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, the company covers more than 36 million lives and delivers 7-12% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.

Studies show that 30% of clinical laboratory testing is unnecessary or overused. Inappropriate testing or missing a key screening can lead to complications and expense arising from unwarranted care, or not obtaining proper care when needed, leading to increased health risks and costs. Avalon helps ensure delivery of the right test, at the right time, and in the right setting. We seek to ensure the most effective patient treatment, improve clinical outcomes, and optimize cost and affordability.

Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies.

Avalon is a high growth company where every associate has an opportunity to make a difference. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com.

Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

Avalon Healthcare Solutions provides and maintains a drug-free workplace for its employees.

About the Clinical Analyst position:

The Clinical Analyst will work closely with Medical Policy and Configuration Management to ensure the proper translation of medical policies into business rules and correct implementation in the Avalon claims editor. The candidate will analyze claim data to identify areas for refinement of medical policy and associated rules. A high degree of familiarity with laboratory medicine and reimbursement is required.

Clinical Analyst – Essential Functions and Responsibilities:

• Develop business rules from medical and payment policies including rationale for interpretation, supporting evidence, and documentation
• Determine coverage overlaps with government programs
• Create test cases to ensure the proper configuration and implementation of business rules into the Avalon Claims Editor

Clinical Analyst – Minimum Qualifications:

• Bachelor of Science or Arts or equivalent
• Strong understanding of laboratory billing and reimbursement practices
• Strong verbal and written communication skills with the ability to simply convey complex subject matter
• High attention to detail and documentation
• Clinical coding experience with a background of ICD-10, CPT, and HCPCS coding principles
• Independent, capable of decision making with limited information
• Prefer Coding certification: RHIT, CPC, CCS or similar

Clinical Analyst – Qualifications Preferred:

• Experience with Centers for Medicare & Medicaid Services (CMS) and industry standard billing, compliance, and reimbursement methodologies.
• Familiarity with commercial payor medical policies
• Familiarity with government programs (Medicare, Medicaid, ACA Marketplace, etc.)
• Knowledge of and experience with laboratory medical coding rules and regulations, compliance, reimbursement, bundling issues.
• Certified Medical Coder - prefer: RHIT, CPC, CCS or similar
• Experience with developing logic associated claims editing
• Experience with data analysis tools
• Biology, chemistry, medicine, nursing, medical technology, or related field of education
• Medical Assistant and/or Nursing a plus

PM18

PI207210298